Healthcare Provider Details

I. General information

NPI: 1871058081
Provider Name (Legal Business Name): DELPHINE BARGUIRDJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 BRIDGTON RD
FRYEBURG ME
04037-1438
US

IV. Provider business mailing address

11 FIELDCREST DR
RAYMOND ME
04071-6031
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-3383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAN1879
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: